{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T01:14:01Z","timestamp":1779930841342,"version":"3.53.1"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T00:00:00Z","timestamp":1629936000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T00:00:00Z","timestamp":1629936000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["RO1 HL116522-01A1"],"award-info":[{"award-number":["RO1 HL116522-01A1"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["SDR 02-237 and 98-004"],"award-info":[{"award-number":["SDR 02-237 and 98-004"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["CDA 19-349-3"],"award-info":[{"award-number":["CDA 19-349-3"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Previous research has found that social risk factors are associated with an increased risk of 30-day readmission. We aimed to assess the association of 5 social risk factors (living alone, lack of social support, marginal housing, substance abuse, and low income) with 30-day Heart Failure (HF) hospital readmissions within the Veterans Health Affairs (VA) and the impact of their inclusion on hospital readmission model performance.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We performed a retrospective cohort study using chart review and VA and Centers for Medicare and Medicaid Services (CMS) administrative data from a random sample of 1,500 elderly (\u2265\u200965 years) Veterans hospitalized for HF in 2012. Using logistic regression, we examined whether any of the social risk factors were associated with 30-day readmission after adjusting for age alone and clinical variables used by CMS in its 30-day risk stratified readmission model. The impact of these five social risk factors on readmission model performance was assessed by comparing c-statistics, likelihood ratio tests, and the Hosmer-Lemeshow goodness-of-fit statistic.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The prevalence varied among the 5 risk factors; low income (47\u2009% vs. 47\u2009%), lives alone (18\u2009% vs. 19\u2009%), substance abuse (14\u2009% vs. 16\u2009%), lacks social support (2\u2009% vs. &lt;1\u2009%), and marginal housing (&lt;\u20091\u2009% vs. 3\u2009%) among readmitted and non-readmitted patients, respectively. Controlling for clinical factors contained in CMS readmission models, a lack of social support was found to be associated with an increased risk of 30-day readmission (OR 4.8, 95\u00a0%CI 1.35\u201317.88), while marginal housing was noted to decrease readmission risk (OR 0.21, 95\u00a0%CI 0.03\u20130.87). Living alone (OR: 0.9, 95\u00a0%CI 0.64\u20131.26), substance abuse (OR 0.91, 95\u00a0%CI 0.67\u20131.22), and having low income (OR 1.01, 95\u00a0%CI 0.77\u20131.31) had no association with HF readmissions. Adding the five social risk factors to a CMS-based model (age and comorbid conditions; c-statistic 0.62) did not improve model performance (c-statistic: 0.62).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>While a lack of social support was associated with 30-day readmission in the VA, its prevalence was low. Moreover, the inclusion of some social risk factors did not improve readmission model performance. In an integrated healthcare system like the VA, social risk factors may have a limited effect on 30-day readmission outcomes.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12913-021-06888-1","type":"journal-article","created":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T16:03:01Z","timestamp":1629993781000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Examining the association of social risk with heart failure readmission in the Veterans Health Administration"],"prefix":"10.1186","volume":"21","author":[{"given":"Charlie M.","family":"Wray","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marzieh","family":"Vali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise C.","family":"Walter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee","family":"Christensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Chapman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Austin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy L.","family":"Byers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salomeh","family":"Keyhani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,26]]},"reference":[{"key":"6888_CR1","doi-asserted-by":"crossref","unstructured":"Krishnamurthi N, Francis J, Fihn SD, Meyer CS, Whooley MA. Leading causes of cardiovascular hospitalization in 8.45 million US veterans. PLoS One. 2018;13(3). Available from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5864414\/. [cited 15 Aug 2019]","DOI":"10.1371\/journal.pone.0193996"},{"issue":"2","key":"6888_CR2","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1111\/1475-6773.13133","volume":"54","author":"KEJ Maddox","year":"2019","unstructured":"Maddox KEJ, Reidhead M, Hu J, Kind AJH, Zaslavsky AM, Nagasako EM, et al. Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program. Health Serv Res. 2019;54(2):327\u201336.","journal-title":"Health Serv Res"},{"issue":"2","key":"6888_CR3","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/s11606-012-2235-x","volume":"28","author":"L Calvillo-King","year":"2013","unstructured":"Calvillo-King L, Arnold D, Eubank KJ, Lo M, Yunyongying P, Stieglitz H, et al. Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: systematic review. J Gen Intern Med. 2013;28(2):269\u201382.","journal-title":"J Gen Intern Med"},{"issue":"1","key":"6888_CR4","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1377\/hlthaff.2013.0816","volume":"33","author":"J Hu","year":"2014","unstructured":"Hu J, Gonsahn MD, Nerenz DR. Socioeconomic status and readmissions: evidence from an urban teaching hospital. Health Aff. 2014;33(1):778\u201385.","journal-title":"Health Aff"},{"issue":"5","key":"6888_CR5","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1177\/1062860617753063","volume":"33","author":"J Hu","year":"2018","unstructured":"Hu J, Kind AJH, Nerenz D. Area deprivation index predicts readmission risk at an urban teaching hospital. 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